Perifoveal exudative vascular anomalous complex (PEVAC) are class of diseases characterized by isolated aneurysmal lesions of the perifovea with hemorrhage and hard exudates, which are found in recent years. Its pathogenesis and pathological process are not yet fully elucidated. The current consensus through multimodal imaging studies is that PEVAC is an idiopathic perifoveal retinal vascular abnormality with cystoid macular edema (CME) and hard exudate. It is not easily distinguished clinically from retinal microaneurysm due to diabetic retinopathy or retinal vein occlusion, aneurysmal telangiectasia, and type 3 macular neovascularization (stage Ⅰ). PEVAC is a partially self-healing property, and some aneurysms and CME may resolve on their own during follow-up period. Laser photocoagulation is an effective measure for the treatment of PEVAC. In the future, with the rapid development of imaging technology, the progress of research on pathogenesis and treatment strategies and the updating of theories are expected to provide more effective treatments for PEVAC.
Objective To investigate the efficacy and prognostic factors of pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR) with chronic renal failure (CRF). MethodsA retrospective study. From January 2016 to June 2021, a total of 82 eyes of 58 patients diagnosed with PDR combined with CRF and treated with PPV in Department of Ophthalmology, The Second Hospital of Hebei Medical University were included in the study. There were 32 cases in males and 26 cases in females. The mean age was (48.45±10.41) years. The course of renal failure was (4.15±3.23) years, and the course of diabetes was (14.45±6.71) years. All patients undergo best-corrected visual acuity (BCVA). The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for recording. The mean number of logMAR BCVA was 2.04±0.82 (0.7-2.8). The duration of vitreous hemorrhage averaged (2.65±1.55) months. There were 38 eyes (46.3%, 38/82) with traction retinal detachment; 32 eyes had a history of panretinal photocoagulation (PRP) treatment (39.0%, 32/82). All eyes were treated with 25G PPV. Patients with traction retinal detachment were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) 3 days before surgery. Opacification of the lens affected the operation operator combined with phacoemulsification. Biochemical indexes such as hemoglobin, glycosylated hemoglobin, albumin, creatinine, uric acid, and alternative treatment (non-dialysis/hemodialysis/peritoneal dialysis) were collected. Postoperative follow-up time was ≥6 months. χ2 test or Fisher's exact test were used for comparison between groups. A logistic regression model was used for multivariate analysis, and Spearman correlation analysis was used to evaluate the correlations between variables. ResultsAt 6 months after surgery, the mean logMAR BCVA was 1.16±0.57. Compared with logMAR BCVA before surgery, the difference was statistically significant (t=－0.837, P＜0.001); 44 eyes had BCVA ≥0.1 and 38 eyes had BCVA ＜0.1. Postoperative vitreous hemorrhage (PVH) was observed in 17 eyes after surgery (20.7%, 17/82). PVH occurred in 15 (46.9%, 15/32), 1 (2.3%, 1/44), and 1 (16.7%, 1/6) eyes in patients without dialysis, hemodialysis and peritoneal dialysis, respectively. There was significant difference between those without dialysis and those on hemodialysis (χ2=26.506, P＜0.05). There was no significant difference between peritoneal dialysis patients and those without dialysis and hemodialysis patients (χ2=2.694, 2.849; P＞0.05). PVH occurred in 3 (10.0%, 3/30) and 14 (27.0%, 14/52) eyes of vitreous cavity filled with silicone oil and perfusion fluid, respectively. The difference was statistically significant (χ2=3.315, P＜0.05); 1 (33.3%, 1/3) and 10 (71.4%, 10/14) eyes were treated with PPV again, respectively, and the difference was statistically significant (P＜0.05). Neovascular glaucoma (NVG) occurred in 12 eyes (14.6%, 12/82). Logistic regression analysis showed that age [odds ratio (OR) =0.911, P＜0.05], diabetic retinopathy (DR) stage (OR=7.229, P＜0.05), renal failure duration (OR=0.850, P＜0.05), operation time (OR=1.135, P＜0.05) was an independent risk factor for poor vision prognosis. Diabetes duration (OR=1.158, P＜0.05), renal failure duration (OR=1.172, P＜0.05) and alternative therapy were independent factors affecting the occurrence of PVH. Diabetes duration (OR=1.138, P＜0.05) and renal failure duration (OR=1.157, P＜0.05) were independent risk factors for postoperative NVG. Spearman correlation analysis showed that PVH was strongly correlated with post-operative NVG (r=0.469, P＜0.01). There was no significant correlation between blood glucose, hemoglobin, creatinine and blood urea nitrogen and prognosis of postoperative vision, PVH and NVG occurrence (P＞0.05). ConclusionsIn PDR patients with CRF, DR Stage, age, renal failure course and operation duration are correlated with vision prognosis. Compared with those who do not receive alternative therapy, hemodialysis treatment can reduce the occurrence of PVH and NVG after surgery.
Central serous chorioretinopathy (CSC) is a common macular disease, which can lead to the loss of central vision in young patients. Although the disease is self-limited to some extent, there is no shortage of patients with prolonged course and recurrent attacks, eventually leading to irreversible visual impairment. Therefore, taking reasonable treatment in a certain period is particularly important for the visual prognosis of patients. Although thermal laser photocoagulation of leakage points and photodynamic therapy (PDT) have achieved good effects, there are risks of retinal damage and retinal pigment epithelium atrophy. Subthreshold micropulse laser (SMLP) is a kind of subthreshold short pulse laser, which does not cause visible damage to the retina and is safer. In the era of lack of PDT drugs, SMLP has gradually become an important means of clinical treatment for CSC, especially for patients with no obvious leakage point or subfoveal leakage point. An in-depth understanding of the mechanism of action of SMLP and its efficacy and safety in the treatment of CSC is helpful for the promotion and application of SMLP in the clinical treatment of CSC.
Objective To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed. MethodsA cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (－13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM. ResultsIn 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio (OR)=16.139, 95% confidence interval (CI) 4.062-64.120, P＜0.001], PS (OR=4.212, 95%CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95%CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS (OR=4.190, 95%CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH (OR=11.323, 95%CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD (OR=1.889, 95%CI 0.580-6.150, P=0.291) or PS (OR=2.778, 1.786; 95%CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH (χ2=20.943, P＜0.001). ConclusionsPM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.
Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave（Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.
ObjectiveTo observe the expression of Rap1, guanosine triphosphate-Rap1 (GTP-Rap1), vascular endothelial growth factor (VEGF) and β-catenin in experimental choroidal neovascularization (CNV).MethodsForty-two brown Norwegian rats were randomly divided into a blank control group (7 rats) and a model group (35 rats). Both eyes were enrolled. The CNV model was established by holmium ion laser photocoagulation in the model group. At 3, 7, 14, 21, and 28 days after photocoagulation, fluorescein fundus angiography (FFA) and choroidal vascular smear were performed to observe the degree of fluorescein leakage and CNV area in rats; Western blot and real-time quantitative polymerase chain reaction (RT-PCR) were used to detect the expression of Rap1, GTP-Rap1, VEGF, β-catenin and mRNA in CNV.ResultsThe results of FFA examination showed that a large disc-shaped fluorescein leaked in the photo-condensation spot 14 days after photocoagulation. Laser confocal microscopy showed that compared with 7 days after photocoagulation, CNV area increased at 14, 21, 28 days after photocoagulation, and the difference were statistically significant (t=3.725, 5.532, 3.605;P＜0.05). Western blot showed that there was no significant difference in the relative expression of Rap1 protein in CNV at different time points after photocoagulation between the two groups (P=0.156). Compared with the blank control group, the relative expression of GTP-Rap1 protein was significantly decreased, the relative expression of VEGF and β-catenin protein were significantly increased in the model group (P=0.000). The results of RT-PCR showed that there was no significant difference in the relative expression of Rap1 mRNA at different time points after photocoagulation between the two groups (P=0.645), but there were significant difference in the relative expression of β-catenin mRNA (P=0.000). At 7, 14, 21 and 28 days after photocoagulation, there were significant difference in the relative expression of GTP-Rap1 and VEGF mRNA between the two groups (P=0.000).ConclusionsThe expression of GTP-Rap1 in experimental CNV is significantly lower than that in normal rats.
ObjectiveTo observe the changes of the structure and visual function of the retina in patients with or without the ectopic inner foveal layers (EIFL) and to explore the factors influencing the recovery of visual function in patients with idiopathic epimacular membrane (IMEM).MethodsA retrospective clinical study. From March 2015 to June 2019, 90 patients with MEM who were diagnosed by Ophthalmic Center of the Second Hospital of Hebei Medical University were enrolled in the study. All patients were examined by best corrected visual acuity (BCVA) and frequency domain optical coherence scan. BCVA was recorded by Snellen vision table, and it was converted into the minimum resolution angle logarithm (logMAR) vision. Among 90 eyes, IMEM grade 2-4 was 68 (75.6%, 68/90), 18 (20.0%, 18/90), 4 (4.4%, 4/90), respectively. According to this, the grade 2 was set as group A, and the grade 3 and grade 4 were combined to group B. There was no significant difference in age (t=0.015), sex composition ratio of patients between two groups (χ2=0.060) and the average of central macular thickness (CMT) (F=2.277) (P=0.904, 0.809, 0.141). The difference of average logMAR and BCVA was statistically significant (F=35.913, P=0.000). All patients underwent 25G pars plana three channel vitrectomy with simultaneous removal of epiretinal membrane and internal limiting membrane. BCVA, CMT and improvement of IMEM grading were observed at 1, 3, 6 and 12 months after operation. BCVA, EIFL thickness and CMT were compared before and after operation by single factor repeated variance analysis; Fisher exact probability method was used to compare the changes of the anatomical structure of the eyes in the two groups at 12 months after operation.Results1, 3, 6, 12 months after operation, the average eyes of logMAR BCVA in group A were 0.50±0.13, 0.38±0.12, 0.27±0.12, 0.19±0.10. The patients in group B were 0.66±0.14, 0.60±0.13, 0.54±0.14, 0.52±0.14. CMT in group A were 364.82±81.29, 281.65±72.45, 228.55±55.34, 182.84±56.13 μm. The patients in group B were 455.88±69.60, 440.18±68.65, 383.76±65.38, 371.39±66.60 μm. The difference was statistically significant in the two groups (BCVA: F=37.913, 11.479, 24.250, 39.013; P=0.000, 0.002, 0.000, 0.000. CMT: F=10.987, 39.610, 55.789, 79.987; P=0.002, 0.000, 0.000, 0.000). In group A, IMEM was improved to 57 eyes of grade 1 on 12 months after operation. Among the 18 eyes in group B, IMEM was improved to 1 and 3 eyes in level 1 and level 2, respectively, and no improvement was found in 4 eyes in grade 4. The difference was statistically significant (P=0.000) in the improvement of the number of eyes in the two groups.ConclusionsThe patients with IMEM without EIFL have better visual prognosis and reversible anatomical changes. EIFL is an important factor affecting the visual function and anatomical structure recovery after operation.